BackgroundThe objective of this study was to compare the outcomes of one-stage posterior surgery involving debridement, bone grafting, and instrumentation with and without local continuous chemotherapy and postural drainage for the treatment of lumbar spinal tuberculosis.MethodsFrom January 2009 to January 2013, 109 patients with lumbar spinal tuberculosis were treated in our center using a posterior surgical approach. Patients underwent one-stage posterior debridement, bone grafting, and instrumentation, without (group A) and with (group B) local continuous chemotherapy and postural drainage. Clinical and radiographic results for the two groups were analyzed and compared. Clinical efficacy was evaluated based on surgery duration and blood loss. The Frankel scale was used to evaluate neurological function. A visual analog scale was used to assess low back pain. Bone graft fusion and instrumentation failure were monitored by radiography, and tuberculosis activity was monitored by erythrocyte sedimentation rate (ESR) and C-reactive protein testing.ResultsGroups A and B contained 52 and 57 patients, respectively. Patients were followed for 18–36 (mean, 26.64 ± 4.2) months. All bone grafts ultimately fused, but the fusion rate was significantly more rapid in group B [6.4 ± 0.5 (range, 5–10) months] than in group A [8.9 ± 0.6 (range, 6–12) months; P < 0.05]. At 6 weeks postoperatively, ESR levels differed significantly between groups A and B (24.6 ± 1.5 vs. 16.3 ± 1.1 mm/h; P < 0.05). ESR levels normalized in both groups at 16 weeks.ConclusionsLocal continuous chemotherapy and postural drainage effectively eliminated infection foci caused by abscess remnants and accelerated interbody bone fusion in patients with lumbar spinal tuberculosis undergoing one-stage posterior surgery involving debridement, bone grafting, and instrumentation.

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The aim of this study was to evaluate the efficacy and feasibility of a life-size 3-dimensional printing assisted posterior internal fixation. We performed a retrospective review of 138 patients who received posterior atlantoaxial internal fixation from October 2009 to March 2015 with a minimum follow-up period of 12 months. Group A included 76 patients who received the conventional free-hand technique. Group B included 62 patients who were treated with internal fixation assisted by 3D printing. The placement accuracy of the screw was evaluated in the computed tomography images according to the methods of Hojo and clinical outcomes were evaluated using the visual analogue scale, the Japanese Orthopedic Association Score, and the Neck Disability Index score. There were no significant differences in the clinical results at any of the follow-up time points regarding the JOA, VAS, or NDI scores between two group. However, compared to Group A, Group B had better results for screw installation (P = 0.003), shorter surgery time (P = 0.001), and less blood loss (P = 0.037). Compared to the conventional free-hand technique, 3D printed model–assisted is helpful to screw placement in atlantoaxial internal fixation, which can be used as a common tool to provides important guidance for upper cervical surgery.